Dental Services Authorization Specialist(Elk Ridge) - Flagstaff Fourth St - General Dentistry

JOB PURPOSE: The Dental Services Authorization Specialist(Elk Ridge) serves as a liaison between the Dental Business Office, in-house providers, external referral sources and health plans while providing service excellent to Elk Ridge Community Health patients and staff. The Dental Services Authorization Specialist(Elk Ridge) is responsible to meet with patients regarding their coverage, prepare cost estimates through the treatment plan, work claim denials, schedule appointments, and supply providers with accurate approvals through the Elk Ridge electronic authorization program. Assists with training staff, and monitoring of workflow at all sites to ensure the department meets the assigned goals and consistently provides world class customer service to patients, providers and all Elk Ridge team members.

The primary goal of the Elk Ridge Community Health Dental Services Authorization Specialist(Elk Ridge) is to support Elk Ridge’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.

Job Functions:

Demonstrates knowledge of Commercial, Medicaid (AHCCCS) and Medicare insurance plans.

Schedules initial and follow-up appointments, for the most complex treatment such as oral surgery, and sedation cases.

Performs Authorization and utilization of dental insurance plans.

Processes authorization claim forms, reviews ICD-10 diagnostic and CDT procedural codes, and overturning denials.

Utilizes billing and coding knowledge and skills to ensure ICD-10 diagnostic coding and CDT procedural codes are consistent and accurate and standardized in documenting dental treatment.

Completes, submits, and reconciles authorization claim forms.

Enters Data entry into electronic health record and/or specified reports in Excel or Elk Ridge Health systems.

Research, corrections and re-submission of denials.

Correlates procedure groupings and timeframes for submitting all or part of the treatment plan for authorization approvals. Determining cost or utilization of grant funds when submitting authorization requests.

General accounting functions.

Meets with patients to discuss treatment plans, insurance coverages and financial responsibilities.

Knowledge and experience submitting authorization requests in-house and/or to outside vendor.

Documentation of approvals, denials, and explanations in the patient’s chart.

Informs and educates updates regarding insurance and authorization changes or new coverages in a group setting.

Maintains an exceptional level of customer service, addresses and resolves patient concerns.

Joint Commission Responsibilities:

Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.

Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Other Duties and Responsibilities:

In support of the Mission and Vision of Elk Ridge Community Health, will at all times represent themselves as a professional role model of Elk Ridge Community Health serving as a positive informational source for members of the community.

Supports Elk Ridge Community Health by participating in community events which promote good health, and which contribute to a broader awareness and understanding of Elk Ridge Community Health and the many services provided to the community.

Participates in all appropriate health care activities related to Elk Ridge Community Health on a local, state, and national level to maintain and enhance Elk Ridge’s image with health agencies, professional associations, and the general public.

Ensures and supports the cost-effective use of materials, supplies, and equipment by limiting waste of all organizational supplies and resources.

In accordance with policies and procedures ensures that documentation of hours worked is completed accurately, as well as signed-off/approved in a timely manner.

Employees must maintain their skills proficiency with Elk Ridge Community Health operating systems and/or software programs by adapting to changing requirements and successfully learning and demonstrating new skills in response to software, system, and program improvements or upgrades.

Performs other duties as assigned.

Qualifications

Minimum Qualifications

Details

Education

High School Diploma or G.E.D.

Experience

Three (3) years’ experience working in a healthcare setting with authorizations, insurance coverage and benefits, claims, billing, and customer service.

Experience

Three (3) years’ experience working with Electronic Health Records (EHR.)

Fingerprint Clearance Card

Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Preferred Qualifications

Experience Details

Education

Bachelor’s Degree in a health care related field from an accredited college or university.

Certificate

Dental Assisting Program Certificate (DA III) and/or state certified.

Certificate

Certified Dental Billing Specialist (CDBS)

Certificate

Certified Patient Account Technician, (CPAT)

Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

Transportation:

Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Elk Ridge Community Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

Elk Ridge Community Health is a Non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards.